Citizens Police Academy Application

Citizens Police Academy Application
Applicant Prerequisites:
- All applicants must truthfully complete and submit an application.
- All applicants must be at least 18 years of age.
- All academy participants will be required to complete a Release From Liability form.
- This program is primarily available to residents of the City of Round Rock, or persons who own or work in a business located within the City. Other applicants may be accepted if space is available.
- Applicants who have been convicted of a violent crime, felony or any crime not in keeping with the goals and spirit of the Academy or the Round Rock Police Department will be disqualified.
- Applicants must have a current and valid drivers license.
Name *

Prefix First Name Middle Name Last Name
Gender *

Male Female
Birth Date *

Month Day Year
Social Security # (last 4 numbers) *
Drivers License # *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone # *

Area Code Phone Number
Alternate Phone #

Area Code Phone Number
Business Name
Business Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
Tell us about you!
Occupation and Job Title *
Referred By? *
In what areas of the community are you already involved *
Have you attended the Round Rock Police Department Citizen's Police Academy in the past? *
Describe why you want to be enrolled in the Citizens Police Academy *
Have you ever been arrested for any offense other than a traffic violation? *

Yes No
Please state when, where and describe the circumstances.
I hereby authorize the Round Rock Police Department to conduct an investigation of my application for the purpose of determining my eligibility to participate in the Citizens Police Academy.
Date *

Month Day Year
Signature *

Clear
Should be Empty:

Citizens Police Academy Application

Applicant Prerequisites:

Tell us about you!